蒙脱石散:18种用途和3项注意!

2022-05-17 基层医师公社 基层医师公社

蒙脱石散用药攻略,18招。

蒙脱石散为肠黏膜保护剂和吸附剂,有吸附肠道毒素和保护肠黏膜的作用,临床可用于治疗急性或慢性腹泻,或辅助用于食管、胃、十二指肠疾病引起的相关疼痛症状
 
那么,此药的药理特点是什么?怎样正确服用?与其他药如何联用?可用于哪些特殊人群呢?
 
用法用量的讲究
 
用法:蒙脱石散会与食物黏附,而降低其附能力,因此建议饭前服用
 
特殊用法:用于急性腹泻时,可减少腹泻次数与腹泻时间,但首次剂量需加倍。可将1袋即3g倒入50毫升温水中,搅匀后服用,但注意药物浓度不可过高或不均匀,以免影响疗效
 
与其他药联用的讲究
 
与抗菌药联用:建议先用抗菌药,再服蒙脱石散,两药间隔至少1小时
 
原因:蒙脱石散一方面可对细菌、病毒及胆盐起有吸附作用,另一方面还可对消化道内的病毒、细菌及其产生的毒素有强固定、抑制作用。所以,先用抗菌药杀灭病原微生物后,再使用蒙脱石散吸附细菌或各种毒素,尤其是致病性革兰阴性菌内毒素。
 
与微生态制剂(益生菌制剂)联用:建议先用蒙脱石散,再用微生态制剂(益生菌制剂),两药间隔至少1小时
 
原因:蒙脱石散可将胃肠道内的细菌或病毒吸附掉,同时对消化道黏膜具有保护和修复作用,再服益生菌制剂恢复肠道正常菌群,改善菌群的紊乱。
 
若上述3种药联合,可先服抗菌药,再用蒙脱石散,最后用益生菌制剂,3药用药间隔至少1小时。另外,因本药有一定的物理吸附作用,建议与别的药物间隔一段时间再服用如1~2小时
 
特殊人群使用的讲究
 
婴幼儿、孕妇、老人:该药服用后不进入血液循环,会和固定的攻击因子一起随消化道自身蠕动排出体外,而不会影响正常的肠蠕动。由此,婴幼儿、孕妇、老人可安全服用
 
X线检查者:蒙脱石散不影响X线检查。
 
18种用途要知道
 
1 治小儿疱疹性口炎
 
疱疹性口炎是由单纯疱疹病毒引起的急性口腔黏膜炎症,蒙脱石散干粉涂于患处,效优于碳酸氢钠,同时蒙脱石散因味道清香而易被儿童接受。
 
蒙脱石散具有较高的定位能力,对多种攻击因子具有吸附和清除作用,促进粘膜细胞的再生与修复。
 
2 治小儿口腔炎
 
小儿口腔炎及口腔溃疡均可用蒙脱石散糊剂外涂于患处,每日3次。外用蒙脱石散治小儿口腔炎,具有明显的止痛作用,并能够促进口腔炎症和溃疡快速恢复,效果良好,可作为常规药物应用。
 
方法:用本品加水调成糊状,较大儿含漱后口服,较小儿局部涂布,3~4次/d,同时配合服用维生素类药物,酌情使用抗生素及镇静退热剂。用药后,平均6~7d痊愈,局部涂抹后10min即可止痛,因疼痛引起的哭闹、拒食症状很快消失。
 
3 治小儿鹅口
 
鹅口疮大多是由白色念珠菌感染的口腔黏膜传染性疾病。
 
有报道使用蒙脱石散治疗小儿鹅口疮50例,效果满意。
 
4 治口腔溃疡
 
方法:先用0.9%氯化钠或冷开水清洗口腔及溃疡面,再用棉签将蒙脱石散涂于溃疡表面,或在蒙脱石散中加几滴鱼肝油调成糊状涂于患处,或将蒙脱石散倒人杯中加适量水搅匀后含漱,每天2~3次。用药后10分钟内禁食、禁饮。
 
据报道,蒙脱石散治疗口腔溃疡患者30例,结果治疗组治愈率为50.00%,总有效率为93.33%。
 
5 治反流性食管炎
 
其病理改变主要是食管黏膜充血、水肿、糜烂或炎性渗出改变,单纯消炎止痛效果不满意。
 
蒙脱石散通过增强消化道黏膜屏障、吸附各种攻击因子、恢复再生上皮组织、平衡寄生菌群、提高免疫球蛋白A的抗攻击能力等可有效缓解症状。
 
联合用药:应用枸橼酸莫沙必利片(加斯清)联合蒙脱石散,3g/次,3次/d,疗程4~6周,总有效率为87.5%。
 
6 治消化性溃疡
 
蒙脱石散通过与黏液蛋白结合,使黏液的黏弹性内聚力增加,同时使黏液层增厚,从质和量两方面改善黏液,并且加速受损黏膜上皮细胞的修复和再生,可防止胃酸、胃蛋白酶、胆盐等对消化道黏膜的侵害,维护消化道功能。
 
另外,研究显示,蒙脱石散还能通过增加胃内表皮生长因子、氨基己糖的水平以加速创面的修复。
 
联合用药:应用蒙脱石散和胶体次枸橼酸铋剂(得乐)治疗的比较显示,蒙脱石散10g/次,3次/d,疗效优于胶体次枸橼酸铋剂,且无明显副作用。
 
7 治新生儿继发性消化道出血
 
用法:在积极治疗原发疾病的同时,将1/3包蒙脱石散加入生理盐水2~3mL调成糊状,3次/d,口服,连用7~10d。
 
蒙脱石散能使低浓度第VII、VIII、XII凝血因子被激活,以加速轻度消化道出血的局部止血作用。用药24h以内止血率29%,3d以内100%止血,优于目前常用的止血药物疗法。
 
8 治甲亢所致恶心呕吐
 
将蒙脱石散3.0~6.0g,3~4次/d试用于甲亢引起的恶心、呕吐,疗效明显优于恩丹西酮。其可能的原因是蒙脱石散除了增强消化道黏膜屏障功能、促进消化道上皮细胞恢复和再生外,尚能作用于阿片受体,阻止乙酰胆碱和前列腺素的释放,抑制胃肠道蠕动,解除内脏平滑肌痉挛。
 
9 治咽下综合征
 
咽下综合征是新生儿出生时咽下污染的羊水或产道血液,刺激胃黏膜引起的呕吐,呕吐物为泡沫黏液或血液。
 
用法:研究显示,蒙脱石散1g/次,1次/3h,共用3次,有效率为88.68%,可替代洗胃法。
 
目前,认为肠易激综合征是包括肠动力异常、肠道菌群失调、炎症等多种因素共同作用的结果。张希权研究显示,蒙脱石散由于其特殊的带电荷和分布不均匀性,可吸附多种病原体及其毒素,并通过改善细胞正常的吸收和分泌功能,减少细胞的运动失调和水、电解质的丢失,从而改善疾病症状。
 
用法:蒙脱石散口服,3次/d,3g/次,连服6周,对该症引起的腹痛、腹胀、腹泻总有效率达83.3%。
 
11 治婴幼儿慢性迁延性腹泻
 
慢性迁延性腹泻是造成小儿营养不良、生长发育障碍及死亡的主要原因之一。
 
联合用药:用蒙脱石散联合庆大霉素灌肠给药,缩短了止泻时间和总病程,且价格低廉、无明显不良反应发生,值得临床推广应用。
 
12 治婴儿乳糖不耐症
 
乳糖不耐症系因患儿体内乳糖酶缺乏而致哺乳后出现腹胀、腹泻、消化不良、体重下降等表现,过去常用维生素B溶液、乳酶生等治疗,效果在40%左右。
 
用法:近年,试用蒙脱石散治疗,每次1/3包,3次/d,口服,疗程3d,结果总有效率达83.3%,其中半数对乳糖恢复耐受,推荐蒙脱石散为治疗本症的首选治疗药物。
 
13 治小儿霉菌性肠炎
 
霉菌性肠炎多出现于体质虚弱、消瘦,或长期接受广谱抗生素、免疫抑制剂等药物而导致肠道菌群失调时。常采用制霉菌素等治疗,因毒副反应较大且疗效较差,患儿不易接受。
 
用法:近年,试用蒙脱石散有显著效果,用法为<1岁者,每次1/3包;1~4岁每次1/2包;>5岁每次1包。口服,3~4次/d.97%有效。
 
14 治小儿复发性腹痛
 
小儿复发性腹痛是因肠道平滑肌痉挛引起的阵发性腹痛,往往反复发作,是儿科门诊常见病。用蒙脱石散治疗50例,有效率达94%,明显优于颠茄或阿托品组。
 
15 治新生儿母乳性黄疸
 
母乳性黄疸多出现于纯母乳喂养的早产儿和低体重儿。一般认为,由于母乳内含有较高浓度的β-葡萄糖醛酸苷酶,此酶进入肠道,将结合胆红素又重新分解为未结合胆红素,经肠壁将未结合胆红素通过肝肠循环吸收,又回到肝脏,加重黄疸。
 
用法:对此,单纯用蒙脱石散10g,口服,3次/d,服用7d,蒙脱石散通过吸附肠道未结合胆红素,减少肠道对未结合胆红素的吸收,100%的患儿黄疸消退,无不良反应出现。
 
溃疡性结肠炎为炎症性肠病之一,治疗难度大,易复发。
 
用法:研究显示,蒙脱石散作为黏膜保护剂,6~12g灌肠,1次/晚,并结合传统疗法,可取得较满意的疗效。
 
17 抢救有机磷农药中毒
 
救治有机磷农药中毒时,随着阿托品的应用,胃肠蠕动逐渐减弱,甚至腹胀气,增加了毒物的重吸收,使重度中毒患者极易出现反跳、中间综合征等一系列严重并发症。
 
蒙脱石散对胃肠道毒物有极强的吸附作用和覆盖能力,并通过与黏液蛋白相互结合、修复,提高黏膜屏障对攻击因子的防御能力,促进胃肠功能的恢复。
 
联合用药:与大黄联合应用治疗口服有机磷农药中毒,可有效防治中毒患者并发的胃肠功能的衰竭,恢复胃肠蠕动,彻底清除肠道内残毒,避免其再吸收,提高了抢救成功率。
 
18 拮抗红霉素的胃肠反应
 
以红霉素为代表的大环内酯类抗生素,因安全性高,无致畸、致突变等不良反应而广泛用于妊娠妇女和儿重,但其促胃肠动力作用使部分用药者产生较明的消化道不适,过去应用654—2等莨菪碱类药物对抗,但副反应较大,患儿不易耐受。
 
用法:近年发现,在输注红霉素10分钟内口服蒙脱石散,1岁以内每次1/4包,1~2岁每次1/2包,大于2岁每次服1包,用药后93.4%的出现不良反应或仅有轻微恶心,可完全耐受应用红霉素治疗,明显优于输液时加用维生素B,或莨菪碱类药物者。
 
总之,由于蒙脱石散系纯天然药品,服后不吸收,不进入血液循环,除个别患者引起便秘、偶有皮疹外,无明显不良反应。因而,蒙脱石散在临床应用越来越广泛,随着其临床应用经验的进一步积累和药理研究的不断深入,其临床用途将进一步拓宽。

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    2022-05-23 ms7000001215278187

    涨姿势了

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1221715, encodeId=08ea1221e15d0, content=涨姿势了, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=231c6153356, createdName=ms7000001215278187, createdTime=Mon May 23 11:07:35 CST 2022, time=2022-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220666, encodeId=034f1220666f2, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220518/77bbeaecad4e41ef94dd19dfd2b699f8/3a062ab20a7d45e597d6522923d4ba43.jpg, createdBy=8cc28150268, createdName=ms6000000148957429, createdTime=Wed May 18 14:37:23 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220801, encodeId=26e81220801dd, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cac52571141, createdName=1258364am39暂无昵称, createdTime=Wed May 18 23:16:26 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220714, encodeId=40341220e1440, content=这个依据在哪里?, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=48065474040, createdName=ms9000002043128496, createdTime=Wed May 18 18:24:47 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220713, encodeId=1a461220e13c3, content=都快成万能药了, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=70178143138, createdName=ms3000002061692810, createdTime=Wed May 18 18:23:21 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220590, encodeId=0d5d1220590bf, content=认真学习~,, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfb41991958, createdName=xulv123, createdTime=Wed May 18 07:11:31 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220588, encodeId=db1a12205886d, content=学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Wed May 18 05:36:16 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220550, encodeId=a6351220550e0, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Ket8m6MIibXhvbjRGgD0H2QkkxMsABMZJJejJzbrE7vj81PFX7Ywct0bbjqz6QVK1y0xFGibylE59nWbjZddGNIg/132, createdBy=74df5244281, createdName=Chen chen1547, createdTime=Tue May 17 21:35:09 CST 2022, time=2022-05-17, status=1, ipAttribution=)]
    2022-05-18 ms6000000148957429

    学习

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1221715, encodeId=08ea1221e15d0, content=涨姿势了, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=231c6153356, createdName=ms7000001215278187, createdTime=Mon May 23 11:07:35 CST 2022, time=2022-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220666, encodeId=034f1220666f2, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220518/77bbeaecad4e41ef94dd19dfd2b699f8/3a062ab20a7d45e597d6522923d4ba43.jpg, createdBy=8cc28150268, createdName=ms6000000148957429, createdTime=Wed May 18 14:37:23 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220801, encodeId=26e81220801dd, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cac52571141, createdName=1258364am39暂无昵称, createdTime=Wed May 18 23:16:26 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220714, encodeId=40341220e1440, content=这个依据在哪里?, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=48065474040, createdName=ms9000002043128496, createdTime=Wed May 18 18:24:47 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220713, encodeId=1a461220e13c3, content=都快成万能药了, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=70178143138, createdName=ms3000002061692810, createdTime=Wed May 18 18:23:21 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220590, encodeId=0d5d1220590bf, content=认真学习~,, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfb41991958, createdName=xulv123, createdTime=Wed May 18 07:11:31 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220588, encodeId=db1a12205886d, content=学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Wed May 18 05:36:16 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220550, encodeId=a6351220550e0, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Ket8m6MIibXhvbjRGgD0H2QkkxMsABMZJJejJzbrE7vj81PFX7Ywct0bbjqz6QVK1y0xFGibylE59nWbjZddGNIg/132, createdBy=74df5244281, createdName=Chen chen1547, createdTime=Tue May 17 21:35:09 CST 2022, time=2022-05-17, status=1, ipAttribution=)]
    2022-05-18 1258364am39暂无昵称

    学习了

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1221715, encodeId=08ea1221e15d0, content=涨姿势了, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=231c6153356, createdName=ms7000001215278187, createdTime=Mon May 23 11:07:35 CST 2022, time=2022-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220666, encodeId=034f1220666f2, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220518/77bbeaecad4e41ef94dd19dfd2b699f8/3a062ab20a7d45e597d6522923d4ba43.jpg, createdBy=8cc28150268, createdName=ms6000000148957429, createdTime=Wed May 18 14:37:23 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220801, encodeId=26e81220801dd, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cac52571141, createdName=1258364am39暂无昵称, createdTime=Wed May 18 23:16:26 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220714, encodeId=40341220e1440, content=这个依据在哪里?, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=48065474040, createdName=ms9000002043128496, createdTime=Wed May 18 18:24:47 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220713, encodeId=1a461220e13c3, content=都快成万能药了, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=70178143138, createdName=ms3000002061692810, createdTime=Wed May 18 18:23:21 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220590, encodeId=0d5d1220590bf, content=认真学习~,, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfb41991958, createdName=xulv123, createdTime=Wed May 18 07:11:31 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220588, encodeId=db1a12205886d, content=学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Wed May 18 05:36:16 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220550, encodeId=a6351220550e0, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Ket8m6MIibXhvbjRGgD0H2QkkxMsABMZJJejJzbrE7vj81PFX7Ywct0bbjqz6QVK1y0xFGibylE59nWbjZddGNIg/132, createdBy=74df5244281, createdName=Chen chen1547, createdTime=Tue May 17 21:35:09 CST 2022, time=2022-05-17, status=1, ipAttribution=)]
    2022-05-18 ms9000002043128496

    这个依据在哪里?

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1221715, encodeId=08ea1221e15d0, content=涨姿势了, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=231c6153356, createdName=ms7000001215278187, createdTime=Mon May 23 11:07:35 CST 2022, time=2022-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220666, encodeId=034f1220666f2, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220518/77bbeaecad4e41ef94dd19dfd2b699f8/3a062ab20a7d45e597d6522923d4ba43.jpg, createdBy=8cc28150268, createdName=ms6000000148957429, createdTime=Wed May 18 14:37:23 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220801, encodeId=26e81220801dd, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cac52571141, createdName=1258364am39暂无昵称, createdTime=Wed May 18 23:16:26 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220714, encodeId=40341220e1440, content=这个依据在哪里?, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=48065474040, createdName=ms9000002043128496, createdTime=Wed May 18 18:24:47 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220713, encodeId=1a461220e13c3, content=都快成万能药了, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=70178143138, createdName=ms3000002061692810, createdTime=Wed May 18 18:23:21 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220590, encodeId=0d5d1220590bf, content=认真学习~,, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfb41991958, createdName=xulv123, createdTime=Wed May 18 07:11:31 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220588, encodeId=db1a12205886d, content=学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Wed May 18 05:36:16 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220550, encodeId=a6351220550e0, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Ket8m6MIibXhvbjRGgD0H2QkkxMsABMZJJejJzbrE7vj81PFX7Ywct0bbjqz6QVK1y0xFGibylE59nWbjZddGNIg/132, createdBy=74df5244281, createdName=Chen chen1547, createdTime=Tue May 17 21:35:09 CST 2022, time=2022-05-17, status=1, ipAttribution=)]
    2022-05-18 ms3000002061692810

    都快成万能药了

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1221715, encodeId=08ea1221e15d0, content=涨姿势了, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=231c6153356, createdName=ms7000001215278187, createdTime=Mon May 23 11:07:35 CST 2022, time=2022-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220666, encodeId=034f1220666f2, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220518/77bbeaecad4e41ef94dd19dfd2b699f8/3a062ab20a7d45e597d6522923d4ba43.jpg, createdBy=8cc28150268, createdName=ms6000000148957429, createdTime=Wed May 18 14:37:23 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220801, encodeId=26e81220801dd, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cac52571141, createdName=1258364am39暂无昵称, createdTime=Wed May 18 23:16:26 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220714, encodeId=40341220e1440, content=这个依据在哪里?, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=48065474040, createdName=ms9000002043128496, createdTime=Wed May 18 18:24:47 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220713, encodeId=1a461220e13c3, content=都快成万能药了, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=70178143138, createdName=ms3000002061692810, createdTime=Wed May 18 18:23:21 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220590, encodeId=0d5d1220590bf, content=认真学习~,, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfb41991958, createdName=xulv123, createdTime=Wed May 18 07:11:31 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220588, encodeId=db1a12205886d, content=学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Wed May 18 05:36:16 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220550, encodeId=a6351220550e0, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Ket8m6MIibXhvbjRGgD0H2QkkxMsABMZJJejJzbrE7vj81PFX7Ywct0bbjqz6QVK1y0xFGibylE59nWbjZddGNIg/132, createdBy=74df5244281, createdName=Chen chen1547, createdTime=Tue May 17 21:35:09 CST 2022, time=2022-05-17, status=1, ipAttribution=)]
    2022-05-18 xulv123

    认真学习~,

    0

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    2022-05-18 学医无涯

    学习一下

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1221715, encodeId=08ea1221e15d0, content=涨姿势了, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=231c6153356, createdName=ms7000001215278187, createdTime=Mon May 23 11:07:35 CST 2022, time=2022-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220666, encodeId=034f1220666f2, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220518/77bbeaecad4e41ef94dd19dfd2b699f8/3a062ab20a7d45e597d6522923d4ba43.jpg, createdBy=8cc28150268, createdName=ms6000000148957429, createdTime=Wed May 18 14:37:23 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220801, encodeId=26e81220801dd, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cac52571141, createdName=1258364am39暂无昵称, createdTime=Wed May 18 23:16:26 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220714, encodeId=40341220e1440, content=这个依据在哪里?, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=48065474040, createdName=ms9000002043128496, createdTime=Wed May 18 18:24:47 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220713, encodeId=1a461220e13c3, content=都快成万能药了, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=70178143138, createdName=ms3000002061692810, createdTime=Wed May 18 18:23:21 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220590, encodeId=0d5d1220590bf, content=认真学习~,, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfb41991958, createdName=xulv123, createdTime=Wed May 18 07:11:31 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220588, encodeId=db1a12205886d, content=学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Wed May 18 05:36:16 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1220550, encodeId=a6351220550e0, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Ket8m6MIibXhvbjRGgD0H2QkkxMsABMZJJejJzbrE7vj81PFX7Ywct0bbjqz6QVK1y0xFGibylE59nWbjZddGNIg/132, createdBy=74df5244281, createdName=Chen chen1547, createdTime=Tue May 17 21:35:09 CST 2022, time=2022-05-17, status=1, ipAttribution=)]
    2022-05-17 Chen chen1547

    0

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